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The Possible Role of Nutraceuticals in the Prevention of Cardiovascular Disease

  • Angela Albarosa Rivellese
  • Paola Ciciola
  • Giuseppina CostabileEmail author
  • Claudia Vetrani
  • Marilena Vitale
Review Article
Part of the following topical collections:
  1. Nutraceuticals in Hypertension & Cardiovascular Prevention

Abstract

Cardiovascular diseases (CVDs) are the main causes of mortality and disability worldwide. Although the initial therapeutic approach to improve the main cardiovascular (CV) risk factors is based on nonpharmacological measures, mainly lifestyle modifications, compliance to recommendations is often poor and inadequate. Therefore, in recent years the use of several nutraceuticals, i.e., nutrients and/or bioactive compounds of plant or microbial origin with potentially healthful effects, has become widespread. However, to date, the scientific data on the possible benefits of the use of nutraceuticals are still inconclusive, due to the absence of adequately controlled intervention studies at least for some of them. Against this background, the scientific evidence derived from controlled intervention studies in relation to the effects of some nutraceuticals (i.e. fiber, phytosterols, soy products, red yeast rice, polyphenols and berberine) on the main CV risk factors (body weight, blood pressure, blood glucose levels and plasma lipids) in humans will be reviewed.

Keywords

Nutraceuticals Blood glucose Plasma lipids Blood pressure Body weight 

Notes

Compliance with Ethical Standards

Conflict of interest

Angela Albarosa Rivellese declares that she has no conflict of interest; Paola Ciciola declares that she has no conflict of interest; Giuseppina Costabile declares that she has no conflict of interest; Claudia Vetrani declares that she has no conflict of interest; Marilena Vitale declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the studies.

References

  1. 1.
    Prabhakaran D, Anand S, Watkins D, Gaziano T, Wu Y, Mbanya JC, et al. Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition. Lancet. 2018;391(10126):1224–36.Google Scholar
  2. 2.
    Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet. 2019;393(10170):434–45.Google Scholar
  3. 3.
    Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Eur Heart J. 2016;37:2315–81.Google Scholar
  4. 4.
    Chapman K. Can people make healthy changes to their diet and maintain them in the long term? A review of the evidence. Appetite. 2010;54(3):433–41.Google Scholar
  5. 5.
    Thompson SV, Hannon BA, An R, Holscher HD. Effects of isolated soluble fiber supplementation on body weight, glycemia, and insulinemia in adults with overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2017;106(6):1514–28.Google Scholar
  6. 6.
    Solah VA, Kerr DA, Hunt WJ, Johnson SK, Boushey CJ, Delp EJ, et al. Effect of fibre supplementation on body weight and composition, frequency of eating and dietary choice in overweight individuals. Nutrients. 2017;9(2):149.Google Scholar
  7. 7.
    Sood N, Baker WL, Coleman CI. Effect of glucomannan on plasma lipid and glucose concentrations, body weight, and blood pressure: systematic review and meta-analysis. Am J Clin Nutr. 2008;88(4):1167–75.Google Scholar
  8. 8.
    Zalewski BM, Chmielewska A, Szajewska H, Keithley JK, Li P, Goldsby TU, et al. Correction of data errors and reanalysis of “The effect of glucomannan on body weight in overweight or obese children and adults: a systematic review of randomized controlled trials”. Nutrition. 2015;31(7–8):1056–7.Google Scholar
  9. 9.
    Abutair AS, Naser IA, Hamed AT. Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial). Nutr J. 2016;15(1):86.Google Scholar
  10. 10.
    Jane M, McKay J, Pal S. Effects of daily consumption of psyllium, oat bran and polyGlycopleX on obesity-related disease risk factors: a critical review. Nutrition. 2018;57:84–91.Google Scholar
  11. 11.
    Georg Jensen M, Kristensen M, Astrup A. Effect of alginate supplementation on weight loss in obese subjects completing a 12-wk energy-restricted diet: a randomized controlled trial. Am J Clin Nutr. 2012;96(1):5–13.Google Scholar
  12. 12.
    Basu A, Sanchez K, Leyva MJ, Wu M, Betts NM, Aston CE, et al. Green tea supplementation affects body weight, lipids, and lipid peroxidation in obese subjects with metabolic syndrome. J Am Coll Nutr. 2010;29(1):31–40.Google Scholar
  13. 13.
    Brown AL, Lane J, Holyoak C, Nicol B, Mayes AE, Dadd T. Health effects of green tea catechins in overweight and obese men: a randomised controlled cross-over trial. Br J Nutr. 2011;106(12):1880–9.Google Scholar
  14. 14.
    Chen IJ, Liu CY, Chiu JP, Hsu CH. Therapeutic effect of high-dose green tea extract on weight reduction: a randomized, double-blind, placebo-controlled clinical trial. Clin Nutr. 2016;35(3):592–9.Google Scholar
  15. 15.
    Belza A, Frandsen E, Kondrup J. Body fat loss achieved by stimulation of thermogenesis by a combination of bioactive food ingredients: a placebo-controlled, double-blind 8-week intervention in obese subjects. Int J Obes (Lond). 2007;31(1):121–30.Google Scholar
  16. 16.
    Phung OJ, Baker WL, Matthews LJ, Lanosa M, Thorne A, Coleman CI. Effect of green tea catechins with or without caffeine on anthropometric measures: a systematic review and meta-analysis. Am J Clin Nutr. 2010;91(1):73–81.Google Scholar
  17. 17.
    Flachs P, Horakova O, Brauner P, Rossmeisl M, Pecina P, Franssen-van Hal N, et al. Polyunsaturated fatty acids of marine origin upregulate mitochondrial biogenesis and induce beta-oxidation in white fat. Diabetologia. 2005;48(11):2365–75.Google Scholar
  18. 18.
    Zhang YY, Liu W, Zhao TY, Tian HM. Efficacy of omega-3 polyunsaturated fatty acids supplementation in managing overweight and obesity: a meta-analysis of randomized clinical trials. J Nutr Health Aging. 2017;21(2):187–92.Google Scholar
  19. 19.
    Jacobo-Cejudo MG, Valdés-Ramos R, Guadarrama-López AL, Pardo-Morales RV, Martínez-Carrillo BE, Harbige LS. Effect of n-3 polyunsaturated fatty acid supplementation on metabolic and inflammatory biomarkers in type 2 diabetes mellitus patients. Nutrients. 2017;9(6):E573.Google Scholar
  20. 20.
    Hill AM, Buckley JD, Murphy KJ, Howe PR. Combining fish-oil supplements with regular aerobic exercise improves body composition and cardiovascular disease risk factors. Am J Clin Nutr. 2007;85(5):1267–74.Google Scholar
  21. 21.
    Munro IA, Garg ML. Dietary supplementation with n-3 PUFA does not promote weight loss when combined with a very-low-energy diet. Br J Nutr. 2012;108(8):1466–74.Google Scholar
  22. 22.
    Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2018;36(12):2284–309.Google Scholar
  23. 23.
    Appel LJ, Giles TD, Black HR, Izzo JL, Materson BJ, Oparil S, et al. ASH position paper: dietary approaches to lower blood pressure. J Clin Hypertens (Greenwich). 2009;11(7):358–68.Google Scholar
  24. 24.
    Streppel MT, Arends LR, van ‘t Veer P, Grobbee DE, Geleijnse JM. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med. 2005;165(2):150–6.Google Scholar
  25. 25.
    Evans CE, Greenwood DC, Threapleton DE, Cleghorn CL, Nykjaer C, Woodhead CE, et al. Effects of dietary fibre type on blood pressure: a systematic review and meta-analysis of randomized controlled trials of healthy individuals. J Hypertens. 2015;33(5):897–911.Google Scholar
  26. 26.
    Khan K, Jovanovski E, Ho HVT, Marques ACR, Zurbau A, Mejia SB, et al. The effect of viscous soluble fiber on blood pressure: a systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2018;28(1):3–13.Google Scholar
  27. 27.
    Zhang H, Liu S, Li L, Mi J, Tian G. The impact of grape seed extract treatment on blood pressure changes: a meta-analysis of 16 randomized controlled trials. Medicine (Baltimore). 2016;95(33):e4247.Google Scholar
  28. 28.
    Desch S, Schmidt J, Kobler D, Sonnabend M, Eitel I, Sareban M, et al. Effect of cocoa products on blood pressure: systematic review and meta-analysis. Am J Hypertens. 2010;23(1):97–103.Google Scholar
  29. 29.
    Ried K, Sullivan T, Fakler P, Frank OR, Stocks NP. Does chocolate reduce blood pressure? A meta-analysis. BMC Med. 2010;8:39.Google Scholar
  30. 30.
    Liu XX, Li SH, Chen JZ, Sun K, Wang XJ, Wang XG, et al. Effect of soy isoflavones on blood pressure: a meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2012;22(6):463–70.Google Scholar
  31. 31.
    Taku K, Lin N, Cai D, Hu J, Zhao X, Zhang Y, et al. Effects of soy isoflavone extract supplements on blood pressure in adult humans: systematic review and meta-analysis of randomized placebo-controlled trials. J Hypertens. 2010;28(10):1971–82.Google Scholar
  32. 32.
    Miller PE, Van Elswyk M, Alexander DD. Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and blood pressure: a meta-analysis of randomized controlled trials. Am J Hypertens. 2014;27(7):885–96.Google Scholar
  33. 33.
    Appel LJ, Miller ER, Seidler AJ, Whelton PK. Does supplementation of diet with ‘fish oil’ reduce blood pressure? A meta-analysis of controlled clinical trials. Arch Intern Med. 1993;153(12):1429–38.Google Scholar
  34. 34.
    Geleijnse JM, Giltay EJ, Grobbee DE, Donders AR, Kok FJ. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens. 2002;20(8):1493–9.Google Scholar
  35. 35.
    Hartweg J, Farmer AJ, Holman RR, Neil A. Potential impact of omega-3 treatment on cardiovascular disease in type 2 diabetes. Curr Opin Lipidol. 2009;20(1):30–8.Google Scholar
  36. 36.
    Xiong X, Wang P, Li X, Zhang Y, Li S. The effects of red yeast rice dietary supplement on blood pressure, lipid profile, and C-reactive protein in hypertension: a systematic review. Crit Rev Food Sci Nutr. 2017;57(9):1831–51.Google Scholar
  37. 37.
    Lan J, Zhao Y, Dong F, Yan Z, Zheng W, Fan J, et al. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. J Ethnopharmacol. 2015;161:69–81.Google Scholar
  38. 38.
    Rosenfeldt FL, Haas SJ, Krum H, Hadj A, Ng K, Leong JY, et al. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum Hypertens. 2007;21(4):297–306.Google Scholar
  39. 39.
    Ho MJ, Li EC, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev. 2016;3:CD007435.Google Scholar
  40. 40.
    Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999;22(2):233–40.Google Scholar
  41. 41.
    Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16(2):434–44.Google Scholar
  42. 42.
    Lawes CM, Parag V, Bennett DA, Suh I, Lam TH, Whitlock G, et al. Blood glucose and risk of cardiovascular disease in the Asia Pacific region. Diabetes Care. 2004;27(12):2836–42.Google Scholar
  43. 43.
    Abutair AS, Naser IA, Hamed AT. The effect of soluble fiber supplementation on metabolic syndrome profile among newly diagnosed type 2 diabetes patients. Clin Nutr Res. 2018;7(1):31–9.Google Scholar
  44. 44.
    Gibb RD, McRorie JW, Russell DA, Hasselblad V, D’Alessio DA. Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus. Am J Clin Nutr. 2015;102(6):1604–14.Google Scholar
  45. 45.
    de Carvalho CM, de Paula TP, Viana LV, Machado VM, de Almeida JC, Azevedo MJ. Plasma glucose and insulin responses after consumption of breakfasts with different sources of soluble fiber in type 2 diabetes patients: a randomized crossover clinical trial. Am J Clin Nutr. 2017;106(5):1238–45.Google Scholar
  46. 46.
    Zhang YB, Chen WH, Guo JJ, Fu ZH, Yi C, Zhang M, et al. Soy isoflavone supplementation could reduce body weight and improve glucose metabolism in non-Asian postmenopausal women—a meta-analysis. Nutrition. 2013;29(1):8–14.Google Scholar
  47. 47.
    Bozzetto L, Annuzzi G, Pacini G, Costabile G, Vetrani C, Vitale M, et al. Polyphenol-rich diets improve glucose metabolism in people at high cardiometabolic risk: a controlled randomised intervention trial. Diabetologia. 2015;58(7):1551–60.Google Scholar
  48. 48.
    Annuzzi G, Bozzetto L, Costabile G, Giacco R, Mangione A, Anniballi G, et al. Diets naturally rich in polyphenols improve fasting and postprandial dyslipidemia and reduce oxidative stress: a randomized controlled trial. Am J Clin Nutr. 2014;99(3):463–71.Google Scholar
  49. 49.
    Vitale M, Vaccaro O, Masulli M, Bonora E, Del Prato S, Giorda CB, et al. Polyphenol intake and cardiovascular risk factors in a population with type 2 diabetes: the TOSCA.IT study. Clin Nutr. 2017;36(6):1686–92.Google Scholar
  50. 50.
    Zheng XX, Xu YL, Li SH, Hui R, Wu YJ, Huang XH. Effects of green tea catechins with or without caffeine on glycemic control in adults: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2013;97(4):750–62.Google Scholar
  51. 51.
    Hooper L, Kay C, Abdelhamid A, Kroon PA, Cohn JS, Rimm EB, et al. Effects of chocolate, cocoa, and flavan-3-ols on cardiovascular health: a systematic review and meta-analysis of randomized trials. Am J Clin Nutr. 2012;95(3):740–51.Google Scholar
  52. 52.
    Fang K, Dong H, Wang D, Gong J, Huang W, Lu F. Soy isoflavones and glucose metabolism in menopausal women: a systematic review and meta-analysis of randomized controlled trials. Mol Nutr Food Res. 2016;60(7):1602–14.Google Scholar
  53. 53.
    de Bock M, Derraik JG, Brennan CM, Biggs JB, Morgan PE, Hodgkinson SC, et al. Olive (Olea europaea L.) leaf polyphenols improve insulin sensitivity in middle-aged overweight men: a randomized, placebo-controlled, crossover trial. PLoS One. 2013;8(3):e57622.Google Scholar
  54. 54.
    Wainstein J, Ganz T, Boaz M, Bar Dayan Y, Dolev E, Kerem Z, et al. Olive leaf extract as a hypoglycemic agent in both human diabetic subjects and in rats. J Med Food. 2012;15(7):605–10.Google Scholar
  55. 55.
    Liu K, Zhou R, Wang B, Mi MT. Effect of resveratrol on glucose control and insulin sensitivity: a meta-analysis of 11 randomized controlled trials. Am J Clin Nutr. 2014;99(6):1510–9.Google Scholar
  56. 56.
    Pirillo A, Catapano AL. Berberine, a plant alkaloid with lipid- and glucose-lowering properties: from in vitro evidence to clinical studies. Atherosclerosis. 2015;243(2):449–61.Google Scholar
  57. 57.
    Pérez-Rubio KG, González-Ortiz M, Martínez-Abundis E, Robles-Cervantes JA, Espinel-Bermúdez MC. Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion. Metab Syndr Relat Disord. 2013;11(5):366–9.Google Scholar
  58. 58.
    Trimarco V, Battistoni A, Tocci G, Coluccia R, Manzi MV, Izzo R, et al. Single blind, multicentre, randomized, controlled trial testing the effects of a novel nutraceutical compound on plasma lipid and cardiovascular risk factors: results of the interim analysis. Nutr Metab Cardiovasc Dis. 2017;27(10):850–7.Google Scholar
  59. 59.
    Pirro M, Mannarino MR, Bianconi V, Simental-Mendía LE, Bagaglia F, Mannarino E, et al. The effects of a nutraceutical combination on plasma lipids and glucose: a systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2016;08(110):76–88.Google Scholar
  60. 60.
    Jain KS, Kathiravan MK, Somani RS, Shishoo CJ. The biology and chemistry of hyperlipidemia. Bioorg Med Chem. 2007;15(14):4674–99.Google Scholar
  61. 61.
    Pirro M, Vetrani C, Bianchi C, Mannarino MR, Bernini F, Rivellese AA. Joint position statement on “Nutraceuticals for the treatment of hypercholesterolemia” of the Italian Society of Diabetology (SID) and of the Italian Society for the Study of Arteriosclerosis (SISA). Nutr Metab Cardiovasc Dis. 2017;27(1):2–17.Google Scholar
  62. 62.
    Tokede OA, Gaziano JM, Djoussé L. Effects of cocoa products/dark chocolate on serum lipids: a meta-analysis. Eur J Clin Nutr. 2011;65(8):879–86.Google Scholar
  63. 63.
    Lin X, Zhang I, Li A, Manson JE, Sesso HD, Wang L, et al. Cocoa flavanol intake and biomarkers for cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. J Nutr. 2016;146(11):2325–33.Google Scholar
  64. 64.
    Zheng XX, Xu YL, Li SH, Liu XX, Hui R, Huang XH. Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials. Am J Clin Nutr. 2011;94(2):601–10.Google Scholar
  65. 65.
    Kim A, Chiu A, Barone MK, Avino D, Wang F, Coleman CI, et al. Green tea catechins decrease total and low-density lipoprotein cholesterol: a systematic review and meta-analysis. J Am Diet Assoc. 2011;111(11):1720–9.Google Scholar
  66. 66.
    Wang D, Chen C, Wang Y, Liu J, Lin R. Effect of black tea consumption on blood cholesterol: a meta-analysis of 15 randomized controlled trials. PLoS One. 2014;9(9):e107711.Google Scholar
  67. 67.
    Zhao Y, Asimi S, Wu K, Zheng J, Li D. Black tea consumption and serum cholesterol concentration: systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2015;34(4):612–9.Google Scholar
  68. 68.
    Hartley L, Flowers N, Holmes J, Clarke A, Stranges S, Hooper L, et al. Green and black tea for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;6:CD009934.Google Scholar
  69. 69.
    Menezes R, Rodriguez-Mateos A, Kaltsatou A, González-Sarrías A, Greyling A, Giannaki C, et al. Impact of flavonols on cardiometabolic biomarkers: a metaanalysis of randomized controlled human trials to explore the role of inter-individual variability. Nutrients. 2017;9(2):E117.Google Scholar
  70. 70.
    Yang L, Ling W, Du Z, Chen Y, Li D, Deng S, et al. Effects of anthocyanins on cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr. 2017;8(5):684–93.Google Scholar
  71. 71.
    Liu C, Sun J, Lu Y, Bo Y. Effects of anthocyanin on serum lipids in dyslipidemia patients: a systematic review and meta-analysis. PLoS One. 2016;11(9):e0162089.Google Scholar
  72. 72.
    Sahebkar A, Serban C, Ursoniu S, Wong ND, Muntner P, Graham IM, et al. Lack of efficacy of resveratrol on C-reactive protein and selected cardiovascular risk factors—results from a systematic review and meta-analysis of randomized controlled trials. Int J Cardiol. 2015;189:47–55.Google Scholar
  73. 73.
    Sahebkar A. Effects of resveratrol supplementation on plasma lipids: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2013;71(12):822–35.Google Scholar
  74. 74.
    Qin Y, Niu K, Zeng Y, Liu P, Yi L, Zhang T, et al. Isoflavones for hypercholesterolaemia in adults. Cochrane Database Syst Rev. 2013;6:CD009518.Google Scholar
  75. 75.
    Bernstein AM, Ding EL, Willett WC, Rimm EB. A meta-analysis shows that docosahexaenoic acid from algal oil reduces serum triglycerides and increases HDL-cholesterol and LDL-cholesterol in persons without coronary heart disease. J Nutr. 2012;142(1):99–104.Google Scholar
  76. 76.
    Chen C, Yu X, Shao S. Effects of omega-3 fatty acid supplementation on glucose control and lipid levels in type 2 diabetes: a meta-analysis. PLoS One. 2015;10(10):e0139565.Google Scholar
  77. 77.
    Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018;7:CD003177.Google Scholar
  78. 78.
    Yan JH, Guan BJ, Gao HY, Peng XE. Omega-3 polyunsaturated fatty acid supplementation and non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(37):e12271.Google Scholar
  79. 79.
    Rivellese AA, Maffettone A, Vessby B, Uusitupa M, Hermansen K, Berglund L, et al. Effects of dietary saturated, monounsaturated and n-3 fatty acids on fasting lipoproteins, LDL size and post-prandial lipid metabolism in healthy subjects. Atherosclerosis. 2003;167(1):149–58.Google Scholar
  80. 80.
    Karalis DG. A review of clinical practice guidelines for the management of hypertriglyceridemia: a focus on high dose omega-3 fatty acids. Adv Ther. 2017;34(2):300–23.Google Scholar
  81. 81.
    EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS), Younes M, Aggett P, Aguilar F, Crebelli R, Dusemund B, Filipi M, et al. Scientific opinion on the safety of monacolins in red yeast rice. EFSA J. 2018;16(8):5368.Google Scholar
  82. 82.
    Huang H, Chi H, Liao D, Zou Y. Effects of coenzyme Q10 on cardiovascular and netabolic biomarkers in overweight and obese patients with type 2 diabetes mellitus: a pooled analysis. Diabetes Metab Syndr Obes Targets Ther. 2018;11:875–86.Google Scholar
  83. 83.
    Sahebkar A, Simental-Mendia LE, Stefanutti C, Pirro M. Supplementation with coenzyme Q10 reduces plasma lipoprotein(a) concentrations but not other lipid indices: a systematic review and meta-analysis. Pharmacol Res. 2016;105:198–209.Google Scholar
  84. 84.
    Jorat MV, Tabrizi R, Mirhosseini N, Lankarani KB, Akbari M, Heydari ST, et al. The effects of coenzyme q10 supplementation on lipid profiles among patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials. Lipids Helath Dis. 2018;17:230.Google Scholar
  85. 85.
    Bianconi V, Mannarino MR, Sahebkar A, Cosentino T, Pirro M. Cholesterol-lowering nutraceuticals affecting vascular function and cardiovascular disease risk. Curr Cardiol Rep. 2018;20:53.Google Scholar

Copyright information

© Italian Society of Hypertension 2019

Authors and Affiliations

  1. 1.Department of Clinical Medicine and Surgery“Federico II” University of NaplesNaplesItaly

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